Saturday 15 October 2011

Life Enhancing (LEn) versus Life Extending (LEx) medical interventions


I believe that people know when they have reached the end of their own 'natural lifespan'.

This can come at a wide range of ages - between extremes of about 60 and 90 years.

Once people reach this natural lifespan, I think they should acknowledge the fact to themselves; and alter their attitude to medical interventions.


Most medical interventions are intended to be Life Extending (LEx) - these may aim at curing - such as antibiotics, and many types of surgery.

Or they may be LEx by virtue of controlling chronic disease - such as insulin replacement in diabetes, or drugs to reduce blood pressure.


But perhaps the very core of medical interventions are related to Life Enhancement - making patients feel better.

The primary example of LEn is analgesia - pain killers - such as aspirin and the opiates; and also symptomatic treatments to improve symptoms like anxiety, or functionally restricting problems such as arthritis of the hip.


Life Enhancing treatments that are effective and safe are (pretty much) always desirable at any age - but the same does not apply to Life Extending treatments.


When a person reaches the end of their natural lifespan, I believe there should be a clear distinction between LEn treatments which are good and desirable, and LEx treatments which are bad and should be avoided.


Another way of conceptualizing this is that after the end of the natural lifespan, medical treatment should only be accepted by a rational chooser when that treatment is palliative in aim (and preferably in effect).

Medical treatment should (rationally) be avoided and refused when it is Life Extending in intention (and perhaps in effect).


I am not at all talking about society/ administrators/ doctors/ relatives preventing access to Life Extending treatment to people beyond a certain age, but instead that people who judge themselves to have reached the end of their natural life span should themselves refuse medical interventions which have a LEx intention.


Another way of conceptualizing this, is that quality of life (equivalent to LEn) should be the priority after the end of natural lifespan - and that patients need to be aware that most LEx treatments will reduce LEn - either due to the more-or-less inevitable side effects of drugs, or the inevitable short-medium term deleterious effects of surgery/ radiotherapy.


In distinguishing between LEx and LEn interventions, I am not talking about anything esoteric or difficult.

For example, it is obvious commonsense that surgery makes people feel worse - in hope of making them feel better.

After the end of the natural life span, if you already feel bad then surgery may be worthwhile as a means to the hoped-for end of making you feel better - but, if you feel okay to begin-with, then surgery is to be avoided.


As a matter of self-defense; even if doctors provide inaccurate or biased advice to say that drug X will make you feel better (when that is untrue) then this will be very obvious after starting the drug.

For example if the patient feels OK and is being treated for 'bad numbers' like a raised blood pressure or high cholesterol (with the implicit aim of reducing 'risk' and extending life span) - then it will immediately be obvious that (in most cases) the medication makes people feel somewhat worse, and therefore should be stopped swiftly because life is being diminished, not enhanced.

For instance, when hypertension (high blood pressure) is mild, there are usually no symptoms; but many or most blood pressure drugs will have side-effects that impair the quality of life to some degree: fatigue/ 'depression' being a common problem. And 'Statin' drugs may cause people to feel and function worse in numerous ways - due to their widespread cellular actions on the body and brain.


When you have reached the end of natural lifespan, then why make the end of your life worse than it need to be in taking Life Extending treatments with the hope of an unnatural life extension which - even if 'successfully' achieved - often leads to many dark years of dementia or severe debility?


We are now in a situation where, for many people, the exhausted and failing human body is artificially kept-going long after it 'wants to die' and would die if nature was simply allowed to take its course.

Humans have for many decades been trying to dispense with, even outlaw, the metaphysical concept of the 'natural' as a basis for the good life. But we cannot do without it.

The end of human life is just one of many situations where we need a concept of what is natural, and where the lack of such has allowed us unwittingly to stray far down a path of misery and wickedness.



dearieme said...

"For instance, when hypertension (high blood pressure) is mild,..": what sort of BPs correspond to "mild"? How good is the evidence that mild elevation of BP is likely to be bad for you (as distinct from perhaps being a correlate of something that might be bad for you)?

In other words, before even considering your general point, how often would detailed examples anyway fail to stand up to critical scrutiny?

Bruce Charlton said...

@dearieme - you are correct that many individual interventions are based on poor/ zero good evidence; but ordinary people have not the ability to challenge professionals on specific issues.

What I think is needed are simple rules of thumb that e.g. refuse all treatment if you are currently feeling OK, and reject ongoing treatment if it makes you feel worse.

Kristor said...

At the other end of the spectrum of interventions, we must also resurrect an understanding of what it is natural and right for humans to eat and drink. E.g., it is not natural and right for humans to eat 150 pounds of sugar per year, as is the case for the average American (the British eat even more). Nor is it natural and right for humans to do nothing but sit. Our bodies are not engineered for these sorts of things.

Many of the disorders that afflict us these days would not so frequently arise in the absence of these physiological insults.

To think that you can eat gobs of sugar with impunity is formally analogous to thinking that the government can print money without limit without harming the economy, or that the best way to prevent war is to disarm, or that promiscuity and homosexuality are perfectly OK, or that divorce is not harmful to children. It is analogous to thinking that you can let lots of aliens into your country without turning your country into something more like their country.

All such pathologies are instances of a refusal to recognize reality, or, having recognized it, to agree with and conform one's life thereto. They are, that is to say, sins. They are therefore all slow forms of suicide; the wages of sin is death.

Bruce Charlton said...


Good points. I think we are - correctly - afraid of how much of life will unravel if we were to evaluate it in terms of what is 'natural'.

One aspect of the natural which is, however, ignored by religious right commentators is 'infanticide' by abandonment - which (by my reading of anthropology) is a 'natural' and relatively common human method of population control in extremis.

The abandonment of newborn babies (under conditions such as too-close birth spacing, environmental stress and starvation, serious congenital handicap) seems to be regarded in many/ most human societies somewhat as a 'venial' sin - not advocated, known to be wrong, highly regrettable, but sometimes necessary.

Something similar applies to the abandonment of the very old and decrepit/ chronically ill.

My assumption is that these are natural practices for humans, and that therefore compelling reasons for not doing them must come from divine revelation.

But it is dishonest to argue against them on the basis that there is a spontaneous human abhorrence against them: there isn't.

And it is dishonest to use rhetorical methods to try and simulate the illusion of spontaneous/ universal abhorrence.